Dealing with a suspected meniscus injury involves a multifaceted approach, encompassing a detailed physical examination, diagnostic imaging, and careful interpretation of symptoms. In this second part of our comprehensive guide, we delve into the various factors and tests that assist in the identification and initial management of meniscus injuries. We'll also guide you through the initial steps to take if you suspect you're dealing with a meniscus tear, and why these actions are crucial for your recovery. Whether you're a health practitioner seeking to enhance your knowledge or someone dealing with knee pain, we invite you to read on and understand the importance of a thorough approach in handling meniscus injuries.
Article Index:
Physical Examination
Conducting a comprehensive physical examination is essential in cases of suspected meniscus injuries. This examination should encompass a detailed history, orthopedic tests, and a neurological assessment. Diagnostic imaging may also play a crucial role in determining the extent of the meniscus injury.
Orthopedic, Neurological and Vascular Testing
The following demonstration videos present common orthopedic, neurological, and peripheral vascular examination tests used in cases of suspected meniscus injuries.
Knee Examination - Effective Orthopaedic Testing - Knee Examination
This video demonstrates some of the common orthopaedic tests we use to examine our patient's knees.
Lower Limb Neuro Examination
The lower limb neurological examination is part of the overall neurological examination process and is used to assess the motor and sensory neurons which supply the lower limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is a valuable tool used for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video, we go over some of the common procedures we perform in daily clinical practice.
Imaging
X-rays
Although X-rays are not highly effective in diagnosing meniscus injuries, they should still be taken, as they provide valuable information that can help rule out degenerative joint changes, fractures, or pathological processes. Recommended views include an anteroposterior weight-bearing view, posteroanterior 45º flexed view, lateral view, and Merchant Patellar view.
Magnetic Resonance Imaging (MRI)
MRI offers some of the best imaging results for meniscus injuries, with an accuracy of 88% for medial meniscal tears and 92% for lateral meniscal tears (3). Interestingly, these accuracy levels are quite similar to those obtained through a comprehensive physical examination. Research shows that a thorough physical examination is an equally valuable diagnostic tool and should be integrated with the information obtained from imaging (3).
However, this doesn't imply that MRI should be disregarded. Rather, it shouldn't be the first procedure performed, especially considering the costs associated with MRI and the fact that equivalent information can be obtained from a comprehensive physical examination (3).
Types of Meniscus Tears
Meniscal tears can be classified into three basic shapes: longitudinal, horizontal, and radial. Complex tears are a combination of these three fundamental shapes. Each tear shape has specific displaced forms:
Longitudinal tear: When displaced, it is known as a "bucket handle tear." This type of tear is one of the most common causes of a locked knee.
Horizontal tear: A displaced horizontal tear is referred to as a "flap tear."
Radial tear: When a radial tear is displaced, it is called a "parrot beak tear" (4).
These classifications help medical professionals better understand the nature of the injury and determine the most appropriate treatment approach. The tear's shape and displacement can impact the healing process and the choice of surgical or non-surgical interventions.
If You Suspect a Meniscus Injury
First and foremost, seek immediate medical attention if you experience any signs of a meniscus tear. It is crucial to determine the severity of the injury.
The extent of your injury will dictate the appropriate strategy for addressing your meniscus tear. Additionally, it is vital to cease all activities that could potentially worsen the knee damage until a medical practitioner has completed their assessment.
Upon Initial Meniscus Injury:
Regardless of the injury's severity, it's crucial to follow the RICE (rest, ice, compression, and elevation) procedure at the onset of a meniscus tear, and here's why:
Rest - Limit stress on the knee to prevent further damage. If needed, use crutches and a neoprene brace to keep the knee locked in extension. Resting allows the injured area to begin the healing process.
Ice – Applying ice to the knee for 20-30 minutes every 2-3 hours helps reduce swelling and inflammation. Cold therapy constricts blood vessels, minimizing pain and discomfort.
Compression - Using an elastic tensor bandage on your knee helps reduce swelling by limiting fluid accumulation in the injured area. It can be used in conjunction with ice for added benefits.
Elevation - Elevating your knee aids in decreasing swelling by promoting blood flow back to the heart. Place your knee on a blanket or pillow to keep it elevated and supported.
Clarifying the Meaning of Rest
Depending on the injury's severity, complete recovery may necessitate resting your knee for several weeks. Initially, you should avoid activities that involve knee flexion. Flexing the knee generates tension in the popliteus and semimembranosus muscles, which are connected to the meniscus, increasing stress in the area.
Clinical Tip: By keeping the injured knee in a locked position, fully extended, you can reduce about 50% of the compressive load on the knee.
Resting the injured leg does NOT mean abstaining from all physical activities. Here's why:
Exercising the non-injured leg's lower extremity helps maintain overall muscle mass in the injured leg. This prevents muscle atrophy in the injured limb.
Working out the opposite leg leads to neurological crossover, which aids in maintaining muscle strength on the injured side without causing further damage.
Using electrical stimulation, like inferential current, can also help prevent muscle atrophy in the injured leg without adding stress to the meniscus.
Conclusion Part 2
In conclusion, Part 2 of this article emphasizes the importance of a thorough physical examination, diagnostic imaging, and understanding the different types of meniscus tears in diagnosing and treating meniscus injuries. Following the RICE protocol and taking a measured approach to rest are crucial during the initial phase of recovery.
While meniscus injuries can be debilitating, understanding the severity of the injury and working with a healthcare professional to develop an appropriate treatment plan can help you return to your normal activities and maintain your knee's long-term health. Stay tuned for the next part of this series, where we will discuss further treatment options and rehabilitation strategies for meniscus injuries.
Note: References for "Knee Pain - Meniscus Injuries are at the end of Part 3.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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